VA Research Finds A Link Between Moral Injuries And Suicide
September 09, 2021
New research from the National Center for Veterans Studies found a link between moral injury, PTSD and suicide among veterans. The study showed that PTSD and the effects of moral injury are similar in many ways but still distinct conditions, each with unique signs and symptoms. However, when PTSD and moral injury converge, the risk of suicide goes up.
A moral injury happens when a person’s actions (or inactions) in a traumatic situation violate their sense of right and wrong. When someone feels that their direct or indirect participation in an event went against their personal moral code, they can feel intense and painful feelings that are hard to reconcile, such as shame, regret, disgust, guilt and anger.
Veterans and military personnel are especially vulnerable to moral injury from their experiences in combat. Examples of potentially morally injurious events in the context of war include:
- Killing or harming others
- Making decisions that affect the survival of others
- Being unable to save others who have been hurt
- Freezing up during dangerous times
- Concealing an event that violates rules or ethics
- Engaging in or witnessing acts of violence toward others and feeling excited or nothing at all
Individuals who have experienced a moral injury often do not seek help because they are ashamed or afraid of being judged. As a result, they may attempt to control or suppress their emotions on their own, leading to drug and alcohol abuse, social isolation and a lack of self-care. Depression, anxiety and functional impairment all may result.
Moral injury and PTSD are similar in that they involve a specific, traumatic event and cause extreme emotions that become difficult to manage. PTSD differs in that it also includes a hyperarousal component. It is possible to experience a moral injury and not meet the standard for PTSD or develop PTSD from a traumatic event that does not call one’s morals into question, but it is common for these conditions to overlap.
When a veteran struggles with moral injury and PTSD, the PTSD and depression symptoms are often much more severe, and the risk of suicide ideation and behavior becomes significantly higher. This is true even for those with a history of suicide ideation and attempts before the moral injury occurred.
Additional studies examining moral injury are in the works. Researchers hope to find effective therapies for those with moral injuries and ways to reduce suicide rates among veterans in the future.